Provider Demographics
NPI:1174187546
Name:COLLMAN, CONSTANCE L (FNP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:L
Last Name:COLLMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-5376
Mailing Address - Country:US
Mailing Address - Phone:928-536-6869
Mailing Address - Fax:928-536-4788
Practice Address - Street 1:423 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5376
Practice Address - Country:US
Practice Address - Phone:928-536-6869
Practice Address - Fax:928-536-4788
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ224146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily